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Palliative Medicine The Research Journal of the EAPC
Article Reviews
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Article Reference |
Reviewer
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| 2003 17(7): |
Morley JS, Bridson J, Nash TP, Miles JB, White S, Makin MK. Low-dose methadone has an analgesic effect in neuropathic pain: a double-blind randomised controlled crossover trial.
Palliative Medicine 2003; 17: 576-587 |
Andrew Davies, Bristol, UK |
| Summary |
This study is a double-blind, randomised, controlled, crossover trial of low-dose methadone in the treatment of chronic, non-malignant, neuropathic pain.
The study methodology was complex: during the first phase of the study patients received 5 days of treatment with methadone 10mg/day, 5 days of identical placebos, and 10 days of no treatment (washout): during the second phase of the study patients received 5 days of treatment with methadone 20mg/day, 5 days of identical placebos, and 10 days of no treatment (washout).
The efficacy / tolerability of the methadone was assessed using a daily diary: patients were asked to rate maximum pain intensity, average pain intensity and pain relief on visual analogue scales, and also to record any side effects.
During phase 2, when the patients were taking 20 mg a day of methadone, there was an improvement in pain control, which reached statistical significance. For example, the mean “average pain intensity” score fell by 6.56 mm as compared to placebo (p = 0.023). During phase 1, when the patients were taking 10 mg methadone a day, there was also an improvement in pain control, although this did not reach statistical significance. The side effects reported in this study were typical opioid-related side effects (nausea and vomiting, constipation).
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| Clinical Aspects |
| The changes in the scores were statistically significant, but were probably not clinically significant in some patients. However, the doses used were fixed, rather than individually titrated. Moreover, the methadone would not have reached steady state during the study. In other words, the patients were probably not receiving optimal therapy. |
| Methods and study design |
| The methods used were relatively unique. However, as stated above, the study protocol did not reproduce normal clinical practice. Also, most of the patients appeared to be “strong” opioid naive, which means that it is difficult to assess the relative impact of methadone’s non-opioid effects, over its opioid effects. |
| Suggestions for further development / Open Questions |
| This is an important study, which adds to the literature on the use of methadone. However, further studies are required to define methadone’s specific role in clinical practice, and, particularly, methadone’s role in the management of opioid poorly-responsive, neuropathic pain. |
NOTE: THE REVIEWER CHOOSE THE PAPER TO REVIEW INDEPENDENTLY.
IT IS BY CASE FOR THIS ISSUE THE SAME PAPER WAS ALSO SELECTED BY THE EDITOR IN CHIEF OF PALLIATIVE MEDICINE AS THE PAPER TO BE PUBLISHED ON OUR WEB AS A DOWNLOAD FILE IN PDF  .
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